Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - annual report - commissioner rules

10-16-1207. Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - annual report - commissioner rules. (1) (a) There is hereby created the health insurance affordability board, which board is responsible for governance of the enterprise established in this part 12. The board consists of the following eleven voting members: (I) The executive director of the exchange or the executive director's designee; (II) The commissioner or the commissioner's designee; and (III) Nine members appointed by the governor, with the consent of the senate, as follows: (A) One member who is employed by a carrier; (B) One member who is a representative of a statewide association of health benefit plans; (C) One member representing primary care health care providers who does not represent a carrier; (D) Three members who are consumers of health care who are not representatives or employees of a hospital, carrier, or other health care industry entity. To the extent possible, the governor shall ensure that the consumer members of the board are individuals who lack affordable offers of coverage from their employers and otherwise struggle to afford to purchase health insurance. (E) One member who represents a health care advocacy organization; (F) One member who is a representative of a business that purchases or otherwise provides health insurance for its employees; and (G) One member who represents a rural, critical access, or independent hospital. (b) To the extent possible, the governor shall attempt to appoint board members who reflect the diversity of the state with regard to race, ethnicity, immigration status, income, wealth, ability, and geography. In considering geographic diversity, the governor shall ensure at least one member resides on the eastern plains and one member resides on the western slope and, to the extent possible, shall attempt to appoint members from each congressional district in the state. (c) The governor shall make initial appointments to the board by October 1, 2020. (2) (a) (I) Except as provided in subsection (2)(a)(II) of this section, the term of office of the members of the board appointed by the governor is four years, and those members may serve no more than two four-year terms. (II) In order to ensure staggered terms of office, the initial term of office of the members of the board is: (A) Two years for the members appointed pursuant to subsections (1)(a)(III)(A), (1)(a)(III)(C), and (1)(a)(III)(F) of this section and for two of the members appointed pursuant to subsection (1)(a)(III)(D) of this section; and (B) Four years for the members appointed pursuant to subsections (1)(a)(III)(B), (1)(a)(III)(E), and (1)(a)(III)(G) of this section and for one of the members appointed pursuant to subsection (1)(a)(III)(D) of this section. (b) Members of the board appointed by the governor serve at the pleasure of the governor and may be removed by the governor. (c) A member who is appointed to fill a vacancy shall serve the remainder of the unexpired term of the member whose vacancy is being filled. (d) Members of the board may be reimbursed for actual and necessary expenses, including any required dependent care and dependent or attendant travel, food, and lodging, while engaged in the performance of official duties of the board. (3) The board shall meet as often as necessary to carry out its duties pursuant to this part 12. (4) The board is authorized to: (a) Implement and administer the enterprise; (b) Establish administrative and accounting procedures for the operation of the enterprise; (c) Recommend, for approval and establishment by the commissioner by rule: (I) The timing and methodology for assessing and collecting the fee and special assessment, subject to section 10-16-1205 (1)(a); (II) The distribution of enterprise revenues allocated for carrier payments and subsidies in a manner that improves affordability for subsidized populations and individuals not eligible for the premium tax credit, medicaid, medicare, or the children's basic health plan; (III) The payments authorized by this part 12 to be made to carriers to reduce the costs of individual health plans for individuals who purchase an individual health benefit plan on the exchange and receive the premium tax credit; and (IV) The parameters for implementing the subsidies for state-subsidized individual health coverage plans authorized by this part 12, including: (A) Repealed. (B) The criteria and procedures for determining whether an individual is a qualified individual eligible to enroll in a state-subsidized individual health coverage plan; (c.5) Further recommend, for approval and establishment by the commissioner by rule, additional parameters for implementing the subsidies for state-subsidized individual health coverage plans authorized by this part 12, including that the coverage required pursuant to state-subsidized individual health coverage plans must: (I) Maximize affordability for qualified individuals; (II) Cover benefits equivalent to those in a qualified health plan; and (III) For a person who, at the time the person applies for state-subsidized coverage, meets the income requirements to qualify for emergency medical assistance pursuant to section 25.5-5-103 and who is a qualified individual who meets the eligibility criteria established in rule pursuant to subsection (4)(c)(IV) of this section, include coverage and plan design that: (A) Maximizes enrollment in the plan; and (B) To the extent possible with available funding, includes cost sharing such that the plan has consumer cost-sharing responsibilities for emergency services equivalent to cost-sharing responsibilities for emergency medical assistance pursuant to section 25.5-5-103; (d) Establish bylaws, as appropriate and consistent with this part 12, for its effective operation; and (e) Seek, accept, and expend gifts, grants, or donations from private or public sources that the enterprise may use for any of the purposes set forth in section 10-16-1205, to cover the costs of ensuring compliance in the individual market with the federal Hyde amendment or a similar amendment, and to cover the costs of ensuring that Coloradans have access to legally protected health-care activities, as defined in section 12-30-121 (1)(d). The enterprise shall consider the feasibility of allocating gifts, grants, or donations received from specific localities or directed to specific localities to be used only in those localities. (4.5) Prior to making any final recommendation pursuant to subsection (4) of this section regarding plans, coverage, and the number of eligible slots, the board shall seek input and recommendations from individuals directly affected by programs funded by the enterprise and shall discuss any input and recommendations received at a board meeting held in accordance with subsection (6) of this section. The board shall provide opportunities for individuals to provide input and recommendations in English and Spanish. (5) The commissioner shall adopt rules necessary for the administration and implementation of this part 12. In adopting the rules, the commissioner shall consider the recommendations of the board and shall express in writing the reasons for any deviation from the board recommendations. (6) Meetings of the board are subject to the open meetings provisions of the Colorado Sunshine Act of 1972, contained in part 4 of article 6 of title 24. Except as otherwise provided in the Colorado Open Records Act, part 2 of article 72 of title 24, or other applicable state or federal law, records of the board and the program are subject to the Colorado Open Records Act. (7) (a) By February 15, 2026, and by every February 15 thereafter, the board shall prepare a report detailing: (I) The total revenue received by the enterprise in the previous calendar year; (II) The share of the total revenue that was received from federal funds; (III) The share of the total revenue that was received from the fee; (IV) If any additional amount of the total revenue was received from any sources other than the federal government or the fee, the specific source of those revenues and the specific amount of revenues for each source; (V) Each specific program that received funding from the enterprise; (VI) Of the total allocation for each program: (A) The share of the total allocation that was from federal funding; and (B) The share of the total allocation that was from state funding and the source of that state funding; (VII) For the reinsurance program, the amount of the actual allocation of state money to the reinsurance program; (VIII) If less than the maximum allowable allocation of state money in the fund was allocated to the reinsurance program, an explanation of why the reinsurance program was not fully funded; (IX) For any allocation that was made at the discretion of the board or commissioner and not defined expressly in statute, an explanation of the allocations, the amount of each allocation, the rationale for the amounts, and the goals intended to be achieved as a result of each allocation; and (X) The amount of surplus in the fund, if any, and an explanation of why the surplus was not allocated to enterprise programs. (b) By February 28, 2026, and by each February 28 thereafter: (I) The board shall submit the report to the house of representatives health and human services committee and the senate health and human services committee, or their successor committees, and the joint budget committee; and (II) The division shall post the report on the division's public-facing website in an easily accessible location and manner. (c) Notwithstanding the requirement in section 24-1-136 (11)(a)(I), the requirement to submit the report specified in this subsection (7) continues indefinitely. Source: L. 2020: Entire part added, (SB 20-215), ch. 201, p. 995, � 1, effective June 30. L. 2022: (4)(c)(IV)(A) repealed and (4)(c.5) added, (HB 22-1289), ch. 399, p. 2835, � 5, effective June 7. L. 2025: (4)(c.5)(III)(C) and (4)(d) amended and (4)(e) added, (HB 25-1309), ch. 233, p. 1106, � 3, effective May 23. L. 2025, 1st Ex. Sess.: (4)(c.5)(III) amended and (4.5) and (7) added, (HB 25B-1006), ch. 10, p. 43, � 4, effective August 28. Cross references: For the legislative declaration in HB 22-1289, see section 1 of chapter 399, Session Laws of Colorado 2022.